Can Oral Insulin Slow Onset of Type 1 Diabetes in High-Risk Patients?

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Can Oral Insulin Slow Onset of Type 1 Diabetes in High-Risk Patients?

Thomas L. Schwenk, MD reviewing Writing Committee for the Type 1 Diabetes TrialNet Oral Insulin Study Group. JAMA 2017 Nov 21.

Treatment had no effect on diabetes incidence in relatives of patients with type 1 diabetes.

In an earlier study, oral insulin did not prevent or delay onset of type 1 diabetes in close relatives of type 1 diabetics, but subgroup analysis suggested a possible benefit in those with higher autoantibody titers (Diabetes Care 2005; 28:1068). To explore this issue, researchers studied 560 nondiabetic first- and second-degree relatives (age range, 3–45 years) of patients with type 1 diabetes. Participants were assessed for diabetes autoantibodies and first-phase insulin release, were sorted into various subgroups, and were randomized to oral insulin (7.5 mg daily) or placebo. The study focused on a subgroup of 389 participants with higher first-phase insulin release.

During median follow-up of 2.7 years, annualized rates of type 1 diabetes onset did not differ significantly between insulin and placebo recipients in either the entire cohort or the high-release subgroup. In one subgroup of 55 patients with low first-phase insulin release, insulin conferred a relative reduction in diabetes incidence that was considered to be exploratory for statistical reasons.

COMMENT

These findings do not support use of oral insulin at a daily dose of 7.5 mg to slow onset of diabetes in high-risk relatives of patients with type 1 diabetes. However, its use in certain subgroups might be worthy of further exploration.

CITATION(S):

Writing Committee for the Type 1 Diabetes TrialNet Oral Insulin Study Group. Effect of oral insulin on prevention of diabetes in relatives of patients with type 1 diabetes: A randomized clinical trial. JAMA 2017 Nov 21; 318:1891. (http://dx.doi.org/10.1001/jama.2017.17070)